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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - C0 Z <br /> APPLICATION FOR LAND USE PERMITS 3 <br /> f — r <br /> N C <br /> OWNEReI FL <br /> TELEPHONE <br /> M � rn d <br /> HOME ADDRESS r r I �1 7 X15 S U O <br /> EMERGENCY/FIRE NUMBER ? D �(�, ROAD NAME <br /> Govt `\ <br /> LEGAL DESCRIPTION(see tax receipt) o�� ' � �, J"r <br /> LV vJ ` m <br /> TYPE OF PERMIT(S):DWELLING/BUILDING c <br /> GARAGE/ACCESSORY STRUCTURE— ADDITION cr <br /> / c <br /> v <br /> CL C) <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION o' <br /> STRUCTURE/ADDITION USE: 9-�''c'S� <br /> B13 <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) 1 1 <br /> A PLOT PLAN MUST BE PROVIDED ON A SEPARATE SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PL6N DRAWING (AERIAL OR TOP VIEW) <br /> OCL <br /> m <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 50 Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m � <br /> NORTH(N). C O <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES, (B)BUILDING(S)TO m It 1 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF LAKE, v l <br /> STREAM OR RIVER. Z <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO BUILD- <br /> INGS, ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER,CONTRACTOR, ETC.,THE PLANS <br /> MUST BE SIGNED AND DATED BY THE OWNER. c <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE <br /> ISSUED. q o 1 <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. .. <br /> CONDITION OF PERMIT: Zc <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT 1,�+ <br /> ISSUANCE. l <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS ETC.,ALLOWED WITHIN 75 FEET OF THE OHWM OF LAKES, <br /> PONDS, RIVER UNLESS SPECIFICALLY PERMITTED. <br /> 5. O / <br /> 6. X 'aOr ,109 <br /> /a T'iY)✓h �Yilrn�t�G� t 1(Q/QC ��'�iin �+ .� 3 a 3F° MT <br /> 7. <br /> v m w C r c? 3 <br /> c . a (D �'° 1 <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Ct. <br /> m <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of n 0 C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize m mi i m <br /> that this Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Is, G3 <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this Information I am m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. ' <br /> 4 <br /> SIGN HERE � � _ m <br /> Sig a of ow r building contractor) (date) <br /> ZONING ADMINISTRATOR 0.W <br /> w en a rd ri Ch`CA <br /> N N N N 01 P CA <br /> R <br /> TOWNSHIP PERMITS MAY BE REQUIRED v, v, c v,v,0 0 <br /> 0000000 <br />